Objective:To investigate the clinical efficacy of different doses of budesonide/formoterol in the treatment of an acute exacerbation of chronic obstructive pulmonary disease in patients.Methods:A total of 200 inpatients with an acute exacerbation of chronic obstructive pulmonary disease graded C/D by global initiative for chronic obstructive lung disease (GOLD) staging system who received treatment in Jiuquan City People's Hospital, China from January to December in 2019 were included in this study. They were randomly divided into a control group and a treatment group ( n = 100/group). Based on anti-infection and expectorant treatment, the treatment group was given inhalation therapy (higher dose budesonide/formoterol, 320 μg/9 μg), while the control group was identically given inhalation therapy (lower dose budesonide/formoterol, 160 μg/4.5 μg), with a total course of 9 days in each group. Before treatment and at 5 and 9 days of treatment, procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), fractional exhaled nitric oxide (FeNO), percentage of eosinophils (EO%), partial pressure of oxygen (PaO 2), lactic acid, interleulin-6 (IL-6), forced expiratory volume in 1 second (FEV 1), the ratio of FEV 1/ forced vital capacity (FVC) were monitored in each group. COPD assessment test (CAT) score, modified Medical Research Council (mMRC) dyspnea score, 6-minute walking test (6MWT), and symptom improvement were determined in each group. Results:Before treatment, there were no significant differences in PCT and PaO 2 between the control and treatment groups (both P > 0.05). There were significant differences in PCT, PaO 2, FeNO, hs-CRP, E0 (%), IL-6, FEV 1, FEV 1/FVC, 6MWT, mMRC, cough, expectoration, shortness of breath and CAT score measured at 5 days of treatment between the treatment and control groups ( t = 2.416, 3.289, 3.982, 4.871, 3.332, 4.098, 5.253, 6.214, 3.843, 7.268, 5.387, 7.392, 5.398, 6.349, all P < 0.05). There were significant differences in PCT, PaO 2, FeNO, hs-CRP, E0 (%), IL-6, FEV 1/FVC, FEV 1, 6MWT, mMRC, cough, expectoration, shortness of breath and CAT score measured at 9 days of treatment between the treatment and control groups ( t = 2.508, 4.032, 2.948, 3.527, 3.118, 5.251, 5.325, 6.338, 2.907, 6.289, 3.246, 2.084, 2.151, 2.527, all P < 0.05). At 5 days of treatment, lactic acid level in the observation group was significantly lower than that in the control group ( t = 4.341, P < 0.05). At 9 days of treatment, there was no significant difference in lactic acid level between the control and observation groups ( t = 1.173, P > 0.05). There was no significant difference in the incidence of adverse reactions between the control and treatment groups [4%(4/100) vs. 5%(5/100), P > 0.05]. Conclusion:Inhalation of high doses of budesonide/formoterol can greatly improve pulmonary function, 6MWT performance, decrease mMRC and CAT scores, alleviate cough, expectoration, shortness of breath, and decrease serum levels of FeNO, hs-CRP, E0(%), IL-6 and other inflammatory factors. Inhalation of higher doses of budesonide/formoterol exhibits better efficacy in the treatment of an acute exacerbation of chronic obstructive pulmonary disease in patients than inhalation of lower doses of budesonide/formoterol.

Objective To analyse the clinical and therapeutic features as well as laboratory findings in bullous pemphigoid with non-bullous lesions as initial manifestation. Methods Clinical data on 34 cases of bullous pemphigoid with non-bullous lesions as initial manifestation were retrospectively analyzed. Results The male to female ratio was 1.83 :1, with a mean age of onset at 59.79±15.63 years. Before typical bullae appeared, patients presented with erythema, papules, papulovesicles' plaques" wheals, nodules,or erythema muitiforme-like lesions, with the most common lesions being erythematous papules and plaques (occumng in 35.29% of these patients). Conclusions Among these patients, nearly 1/3 displayed various skin lesions at the onset; simultaneous erythematous papules and plaques are the most common initial manifestation.

Objective:To investigate the effects of the Paecilomyces Lilacinuson extracellular polysaccharides on the phenotypic and maturation of murine dendritic cells. Methods: Imature DCs were induced in vitro from the murine bone marrow cells in the presence of rmGM-CSF and rmIL-4, and then they were cultured with different dosage of the extracellular polysaccharides. The morphological characterization was analyzed under microscopy. The expressions of the DCs surface costimulating factors and phagocytic function to FITC-dextran were detected by flow cytometry. The level of IL-12 secreted by DCs was observed by ELISA. At the same time the influence of DCs on the proliferation of T cells was determined by MTT. Results:Treating with the polysaccharides for 48 h could up-regulate the expression of DCs surface molecules,such as CD11c,MHCⅡ,CD80 and CD86,and the 400 μg/ml was the optimal dose,comparing with the blank control group, the difference was significant (P<0. 01), contrast to LPS control group that was not different ( P<0. 05 ) . The uptaking FITC-dextran ability of the DCs treated with 300 μg/ml and 400 μg/ml polysaccharides was significant lower than the unstimulated DCs(P<0. 05). At the same time the extract at different concentration could distinctly enhance the proliferation of T cells by DCs too. Conclusion:The extracellular polysaccharides could stimulate the maturation of dendritic cells and induce the production of mature dendritic cells.

The activity of the NK cells in patients with preeclampsia was studied to investigate the pathogenesis of preeclampsia. By using MTT and 51Cr releasing technique, the proliferation and killing ability of the NK cells in maternal and umbilical blood from preeclampsia patients (n = 18) and normal third trimester pregnant women (n = 18) were detected. The NK-92 cell line was as the positive control. The results showed that the NK cell counts of umbilical blood in preeclampsia patients and normal third trimester pregnant women were significantly greater than those of maternal blood (both P<0.05). Compared with that in normal third trimester pregnant women, the proliferative ability of the NK cells in preeclampsia patients was apparently increased (P<0.05). Compared with that in maternal blood, the proliferative ability of the NK cells in umbilical blood from both preeclampsia patients and normal third trimester pregnant women was dramatically increased. The killing ability of the NK cells in preeclampsia patients was significantly higher than that in normal third trimester pregnant women (P <0.05). It was suggested that both number and function of the NK cells in preeclampsia women were increased, and that in umbilical blood was greater than that in maternal blood, speculating that the function of the NK cells may affect the maintenance of the maternal and fetal immune tolerance during pregnancy.
Cytotoxicity, Immunologic/*immunology ; Fetal Blood/cytology ; Immune Tolerance ; Killer Cells, Natural/*immunology ; Killer Cells, Natural/pathology ; Pre-Eclampsia/blood ; Pre-Eclampsia/*immunology ; Pregnancy Trimester, Third

The activity of the NK cells in patients with preeclampsia was studied to investigate the pathogenesis of preeclampsia. By using MTT and 51Cr releasing technique, the proliferation and killing ability of the NK cells in maternal and umbilical blood from preeclampsia patients (n = 18) and normal third trimester pregnant women (n = 18) were detected. The NK-92 cell line was as the positive control. The results showed that the NK cell counts of umbilical blood in preeclampsia patients and normal third trimester pregnant women were significantly greater than those of maternal blood (both P<0.05). Compared with that in normal third trimester pregnant women, the proliferative ability of the NK cells in preeclampsia patients was apparently increased (P<0.05). Compared with that in maternal blood, the proliferative ability of the NK cells in umbilical blood from both preeclampsia patients and normal third trimester pregnant women was dramatically increased. The killing ability of the NK cells in preeclampsia patients was significantly higher than that in normal third trimester pregnant women (P <0.05). It was suggested that both number and function of the NK cells in preeclampsia women were increased, and that in umbilical blood was greater than that in maternal blood, speculating that the function of the NK cells may affect the maintenance of the maternal and fetal immune tolerance during pregnancy.
Adult ; Cytotoxicity, Immunologic ; immunology ; Female ; Fetal Blood ; cytology ; Humans ; Immune Tolerance ; Killer Cells, Natural ; immunology ; pathology ; Pre-Eclampsia ; blood ; immunology ; Pregnancy ; Pregnancy Trimester, Third

OBJECTIVE To investigated the anti-de-pressant effects of the fruit Areca catechu L.(ACL)and elucidated its potential underlying mechanism using a rat model of chronic unpredictable mild stress(CUMS).METHODS CUMS was induced in rats to establish a depression animal model for 28 d.According to the baseline sucrose preference,the male rats were divided into six different groups.They were treated with parox-etine hydrochloride,ACL,and water once a day until the behavioral tests were performed.The levels of corticoste-rone(CORT),malondialdehyde(MDA),catalase(CAT),and total superoxide dismutase(T-SOD)in serum were de-tected using a commercial kit,and the concentrations of 5-hydroxytryptamine(5-HT)and dopamine(DA)mono-amine neurotransmitters in the brain tissues were detect-ed by liquid chromatography-tandem mass spectrometry.Doublecortin(DCX)expression in the hippocampal den-tate gyrus(DG)was determined by immunofluorescence,and the relative abundance of brain-derived neurotrophic factor(BDNF),TrkB,PI3K,p-Akt/Akt,PSD-95,and p-GSK-3β/GSK-3β of brain tissues were assayed by West-ern blotting.RESULTS ACL markedly increased sucrose preference,decreased the immobility time,and short-ened the feeding latency of CUMS-induced rats.CUMS induction resulted in marked changes in the contents of the monoamine neurotransmitters(5-HT and DA)in the hippocampus and cortex of brain tissues and the levels of CORT,MDA,CAT,and T-SOD in serum,whereas ACL administration alleviated these considerable changes.ACL promoted DCX expression in DG and increased the protein levels of BDNF,TrkB,PI3K,p-Akt/Akt,PSD-95,and p-GSK-3β/GSK-3β in the brains of CUMS-induced rats.CONCLUSION Our results indicated that ACL may improve depression-like behaviors in CUMS-induced rats by decreasing the hyperfunction and oxidative stress of the hypothalamic-pituitary-adrenal axis,stimulating hippo-campal neurogenesis,and activating the BDNF signaling pathway.

OBJECTIVE To investigate and analysis of hearing status and characteristics of China civil aviation air traffic controllers(ATC). METHODS With cluster random sampling, air conduction threshold data of 1498 ATC, who had finished the class Ⅲa medical assessment this year in a certain area were studied. The subjects were tested by pure tone audiometry, the prevalence rate of speech and high frequency hearing loss between gender groups were compared; After age correction, the threshold of different frequencies were compared between age groups. RESULTS The prevalence rate of hearing loss at speech frequency was 6.68％ in male and 1.97％ in female. The result of high frequency was 7.87％ and 1.23％ respectively. Both the threshold and prevalence rate of hearing loss of every frequency were higher in male(P<0.05); The threshold of 3000 Hz

Objective To investigate the effect of a three-tier delirium care management process in patients with acute stroke in neurology intensive care unit(NICU).Methods A total of 50 patients with acute stroke admitted to the NICU of the Fourth Hospital of Changsha from May to September 2021 were assigned to the control group.The patients in the control group received routine NICU nursing care to prevent delirium.Another 50 patients with acute stroke admitted to the NICU from December 2021 to April 2022 were assigned to the trial group.They were managed with the three-tier delirium nursing management process on top of the routine NICU nursing care for the control group.The incidence of ICU delirium(DICU),duration of DICU,length of stay in NICU and the incidence of delirium-related adverse events were compared between the two groups.The degree of delirium and cognitive function before and after the intervention were compared between the two groups as well.Results The trial group had significantly shorter duration of DICU and NICU stay(both P<0.05)and lower incidence rate of delirium-related adverse events(P<0.05)compared to the control group.After the intervention,the trial group showed significantly lower scores on the intensive care delirium screening checklist(ICDSC)and significantly higher scores of cognitive function compared to those of the control group(both P<0.05).Conclusion The three-tier delirium nursing management process can lower the occurrence of delirium in NICU patients with acute stroke,shorten the NICU stay,reduce the safety risk in nursing,and improve the cognitive function.

Objective To investigate the role of P-I-R classification and Laennec grading in evaluating histological changes in patients with hepatitis B cirrhosis after receiving antiviral therapy, as well as the association of these two evaluation systems with clinical prognosis. Methods A total of 218 patients from 14 centers were consecutively screened from October 2013 to October 2014, and these patients were diagnosed with liver cirrhosis based on pathology (Ishak score ≥5), received antiviral therapy for 72 weeks, completed two liver biopsies, and met the P-I-R classification criteria. The 218 patients were divided into non-hepatocellular carcinoma (HCC) group with 186 patients and HCC group with 32 patients. The chi-square test and the Fisher's exact test were used for comparison of categorical data between groups. For the comparison of HCC after antiviral therapy, the non-parametric Mann-Whitney U test was used for continuous variables, and for the comparison of P-I-R classification and Laennec grading, the non-parametric Kruskal-Wallis H test was used for continuous variables. Univariate and multivariate Cox regression analyses were used to calculate hazard ratio ( HR ) and 95% confidence interval ( CI ), and the Kaplan-Meier method was used to calculate the cumulative incidence rate of HCC. Results After 72 weeks of antiviral therapy, there was a significant difference in P-I-R classification between the non-HCC group and the HCC group ( P < 0.001). There were significant differences in the distribution of Laennec grading and P-I-R classification before and after antiviral therapy ( P < 0.001). After antiviral therapy, the 218 patients were divided into 4A group with 33 patients, 4B group with 71 patients, and 4C group with 114 patients according to Laennec grading, and there were significant differences between these three groups in platelet count (PLT) ( H =36.429, P < 0.001), liver stiffness measurement (LSM) ( H =13.983, P =0.004), Ishak score ( χ 2 =23.060, P < 0.001), and HAI score ( P < 0.001). After antiviral therapy, the 218 patients were divided into R group with 70 patients, I group with 52 patients, and P group with 96 patients according to P-I-R classification, and there were significant differences between these three groups in PLT ( H =7.193, P =0.028), LSM ( H =6.238, P =0.045), Ishak score ( χ 2 =7.986, P < 0.001), HAI score ( P =0.002), and HCC ( P < 0.001). There was a significant difference in the incidence rate of HCC between the P and R groups based on P-I-R classification ( HR =24.21, 95% CI : 0.46-177.99, P =0.002). After adjustment for other confounding factors, P-I-R classification was an independent predictive factor for HCC ( HR =12.69, 95% CI : 4.63-34.80, P =0.002). Conclusion Both P-I-R classification and Laennec grading can reflect the features and changes of fibrosis before and after antiviral therapy, and P-I-R classification is more sensitive to fibrosis changes after antiviral therapy. P-I-R classification (after treatment) can be used to assess the risk of HCC in patients after antiviral therapy.